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�/°'' Body Art Inspection Report <br /> Date: June 19,2024 <br /> l� �l San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 952C5 <br /> Record: SR0087836 <br /> (209)468-3420 <br /> \`o �e• www.siogv.org/ehd Program <br /> �4�lFoa�i Element: 4103 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0538823 Erick Jimenez no BBP <br /> Observations and Corrective Actions: <br /> 6. HSC 119315-Invoices and log kept for disposable, pre-sterilized equipment <br /> OBSERVATIONS: <br /> Sterilization certificates were not available for the Tattoo Express(XXX) cartridges with the lot#23-05 or the Cheyenne cartridges <br /> with the lot#2023-41-042. <br /> CORRECTIVE ACTIONS: <br /> A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, <br /> date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. Provide sterilization certificates to the EHD for the needle cartridges mentioned above. <br /> 7. HSC 119314-Sharps containers labeled, used, and disposed of appropriately <br /> OBSERVATIONS <br /> Facility intends to utilize Stericycle as the waste hauler, but a contract was not available for review. <br /> CORRECTIVE ACTIONS: <br /> The sharps waste container shall be within arm's reach and labeled with the word"sharps waste"or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. Provide EHD a copy of a contract between the facility and a <br /> sharps disposal company. <br /> 13. HSC 119307 -Bloodborne Pathogen training <br /> OBSERVATIONS: <br /> A current Bloodborne Pathogen Training Certificate was not available for Erick Jimenez. <br /> CORRECTIVE ACTIONS: <br /> Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section. <br /> Provide a copy a current BBP Training Certificate to the EDH from the approved course list. <br /> 18. HSC 119303 -Client records approved and available-Consent form and questionnaire <br /> OBSERVATIONS: <br /> 1. The client consent form did not have all the items from Form B. <br /> 2. The medical questionnaire did not have all the items listed on Form B. <br /> 3. Some of the client records did have the client's photo ID or the lot number of the instrument used on the client. <br /> CORRECTIVE ACTIONS: <br /> 1.The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. Include the following items on the client consent form and provide an updated copy to the EHD: <br /> - Description of what the client should expect following the procedure. <br /> 2. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. Include the following on the medical questionnaire and provide a copy to the EHD: <br /> - History of herpes infection at the procedure site. <br /> - History of allergic reactions to antibiotics. <br /> Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />